血管内皮生长因子、肿瘤坏死因子-α、CD1a、γδTCR^＋ T在胸腔积液和外周血中表达及其对肺结核和肺癌的诊断价值

Expressions of vascular endothelial growth factor,tumor necrosis factor-α,CD1a and γδTCR^+ T in pleural effusion and peripheral blood and their diagnostic value analysis for tuberculosis and lung cancer

目的探讨血管内皮生长因子(VEGF)、肿瘤坏死因子(TNF-α)和CD1a、γδTCR+T在胸腔积液和外周血中的表达及其对胸腔积液诊断的价值分析,以及TNF-α表达与结核性胸膜肥厚的关系。方法对36例结核性胸膜炎合并胸腔积液和34例肺癌合并胸腔积液患者,用ELISA法检测VEGF、TNF-α在胸腔积液和外周血中表达;用流式细胞仪检测CD1a、γδTCR+T在胸腔积液和外周血中阳性表达,分析TNF-α表达与结核性胸膜炎患者胸膜肥厚的关系。60例健康人的外周血作对照。结果肺癌患者胸腔积液中VEGF的含量高于结核性胸腔积液(P<0.05),而TNF-α含量却低于结核性胸腔积液(P<0.001)。结核性胸腔积液患者外周血中VEGF表达与健康人外周血中表达差异无统计学意义(P>0.05),而肺癌胸腔积液患者外周血中VEGF表达却明显高于结核患者和健康对照组,差异有统计学意义(P<0.001);结核性胸腔积液患者外周血中TNF-α表达与健康对照组、肺癌胸腔积液患者外周血比较差异有统计学意义(P<0.01)。结核性胸腔积液中TNF-α的表达与胸膜肥厚的程度呈正相关(r=0.463,P<0.01)。肺癌胸腔积液中CD1a、γδTCR+T阳性表达明显高于结核性胸腔积液(P<0.001),也高于其自身外周血中的表达(P<0.001);两组患者外周血中CD1a、γδTCR+T阳性表达与健康对照组差异无统计学意义(P>0.05)。结论VEGF、TNF-α表达及CD1a、γδTCR+T阳性表达,可作为结核性胸膜炎合并胸腔积液与肺癌并胸腔积液鉴别诊断的参考依据;结核性胸膜肥厚程度与TNF-α的表达呈正相关。

Objective To explore the expressions of vascular endothelial growth factor（VEGF）,tumor necrosis factor-alpha（TNF-α）,γδTCR^＋ Tnd CD1a in pleural effusion and peripheral blood,and their diagnostic value analysis for tuberculosis and lung cancer,as well as the relation of TNF-α and pachynsis pleurae.Methods Thirty-six cases of tuberculous（TB）pleurisy with pleural effusion and 34 cases of lung cancer with pleural effusion were selected.The concentration of VEGF and TNF-α in the two groups pleural effusions of tuberculous and lung cancer and peripheral blood were measured by enzyme linked immunosorbent assay（ELISA）.The positive expression of γδTCR^＋ Tnd CD1a in pleural effusion and peripheral blood were detected by flow cytometry.To analyze the relation between TNF-α and pachynsis pleurae with tuberculous pleurisy.Peripheral 61 blood of healthy individuals were used as control.Results The concentration of VEGF in lung cancer effusion was significantly higher than that of tuberculous pleural effusion（P〈0.05）,while TNF-α was significantly lower compared with tuberculous pleural effusion（P〈0.001）.No statistical significance was found in the concentration of VEGF in peripheral blood between tuberculous cases and healthy individuals（P〉0.05）,however,the VEGF concentration in peripheral blood was obviously higher in lung cancer cases than in the other two groups（P〈0.001）.The concentration of TNF-α in tuberculous cases was higher than that of lung cancer cases and controls in peripheral blood（P〈0.01）.There was a positive correlation between the concentration of TNF-α and the degree of pachynsis pleurae in tuberculous cases（r=0.463,P〈0.01）.The expression of γδTCR^＋ Tnd CD1a＋ in lung cancer effusion was significantly higher than that of tuberculous pleural effusion（P〈0.001）.The expression of γδTCR^＋ Tnd CD1a^＋ in lung cancer effusion was significantly higher than that of peripheral blood in lung cancer group（P〈0.001）.There was no statistical significance in peripheral blood between the tuberculous,lung cancer cases and controls（P〉0.05）.Conclusions The concentration of VEGF and TNF-α,the expression of γδTCR^＋ Tnd CD1a^＋ may be used as tools for the diagnosis of tuberculous pleurisy with pleural effusion and lung cancer with pleural effusion.The concentration of TNF-α in pleural effusion is positively correlated to the degree of residual pleural thickening in tuberculous cases.